SEVERAL HOURS AFTER A WOMAN ARRIVED at a hospital in labor, the fetal heart rate dropped to 60 beats/min. The on-call ObGyn performed a cesarean delivery 90 minutes later. The child has permanent neurologic disabilities, receives nourishment through a gastric tube, and will require full-time assistance for life.
PATIENT’S CLAIM The 90-minute delay in performing cesarean delivery caused brain damage. A compressed umbilical cord reduced the oxygen supply, compromised the fetal heart rate, and led to brain damage. There were delays in notifying the physician, assembling the surgical team, and taking the mother to the operating room. The ObGyn failed to inform the mother she could have an expedited cesarean section under local anesthesia.
DEFENDANTS’ DEFENSE The ObGyn claimed that a placental infection caused the child’s brain damage. The hospital claimed that the physician was called immediately, the surgical team was gathered as quickly as possible, and cesarean delivery was performed in a timely manner.
VERDICT An $8.5 million New Jersey settlement was reached, including $6 million for the child and $2.5 million for the parents.
PPH untreated—blood could not be found
AT AGE 36, A WOMAN GAVE BIRTH to her first child by cesarean delivery. She developed postpartum hemorrhage, but surgery was not performed because physicians believed the hospital did not have enough matched blood for a transfusion. The woman died.
It was later determined that the hospital did have the appropriate blood in its refrigerator. The estate reached a confidential settlement with the delivering physician, leaving only the hospital as defendant at trial.
ESTATE’S CLAIM The hospital failed to maintain an adequate stock of blood, failed to follow policy in procuring emergency blood, and failed to provide blood in a timely manner.
In discovery, the estate learned that a janitor had been sent to procure blood, despite hospital policy requiring that emergency blood be delivered by law enforcement. An order to type and screen the patient’s blood was given before cesarean delivery, but was not carried out for hours. The woman was type A-negative, which the hospital did not stock. The hospital did have A-positive and O-positive blood, which could have been used, but the physicians were not told it was available.
HOSPITAL’S DEFENSE The physician should have performed surgery. Blood was not needed for the procedure that would have saved the woman’s life. Her death was due to peripartum cardiomyopathy.
VERDICT A $4,623,924 Minnesota verdict was returned.
- Have you made best use of the Bakri balloon in PPH?
Robert L. Barbieri, MD (July 2011)
Were non-stress tests interpreted accurately?
A MOTHER BEGAN TO EXPERIENCE irregular contractions and decreased fetal movement at 38 weeks’ gestation. Her ObGyn sent her to the emergency department for a non-stress test and fetal ultrasonography. The tests were interpreted as normal, and she was discharged.
When she saw her ObGyn the next day, he repeated the non-stress test, and found the results to be reassuring and reactive.
Two days later, the ObGyn was unable to find a fetal heartbeat. He sent the woman to the hospital, where a diagnosis of intrauterine fetal demise at term was made. After attempts to induce labor were unsuccessful, a cesarean delivery was performed, and a 10-lb, 8-oz stillborn baby was delivered. The pathologist was unable to define a cause of death at autopsy.
PATIENT’S CLAIM The physician was negligent in failing to properly interpret the non-stress tests. Because of the mother’s symptoms, additional testing should have been performed that would have revealed fetal compromise, and led to delivery of a healthy baby.
PHYSICIAN’S DEFENSE The treatment provided was appropriate. The non-stress tests were properly interpreted.
VERDICT An Illinois defense verdict was returned.
Child’s arm paralyzed despite mother’s expressed concern
WHEN PREGNANT A SECOND TIME, a woman reported to Dr. A, a member of an ObGyn group, that she had a history of gestational diabetes, and that her first child had been large but had been delivered vaginally. At 28 weeks’ gestation, screening was negative for gestational diabetes. Two prenatal sonograms, performed at 35 and 37 weeks’ gestation, showed a large fetus.
The woman went into labor at 39 weeks. Dr. B, an associate of Dr. A, encountered shoulder dystocia, but freed the shoulder and completed the vaginal delivery. The baby had Apgar scores of 2, 3, and 7. He was given a diagnosis of separation of four of five nerve roots in his shoulder and has complete paralysis of the right arm, from biceps to fingers.